| Irritable bowel syndrome (IBS) is the most common diagnosis with a worldwide prevalence of approximately 10%. IBS is characterized by abdominal pain and change to bowel habits in the absence of an organic cause, and symptomatically is often accompanied by complaints of bloating and abdominal distension. IBS incurs heavy economic and social burdens on the individual as well as society. IBS is also associated with poorer quality of life. Recent advances in the understanding of the pathophysiology of IBS include brain-gut disturbances, increased intestinal permeability and alterations in the immune function. The diagnosis of IBS can be confidently made by identifying typical symptoms using the Rome IV criteria, evaluating for alarm features and limited diagnostic testing. The cornerstone of treatment is establishing a therapeutic doctor-patient relationship, improving life-style factors and diet. For example, clinical significant improvement in symptoms has been shown in a randomized controlled trial comparing an ‘augmented’ clinician-patient interaction to a ‘limited’ interaction and both were superior to a ‘no-interaction’ control. Likewise, diets, such as the low-FODMAP diet, which reduces poor absorbed sugars from the diet, has been shown to be superior to a typical Australian diet. Patients with persistent symptoms can be offered a number of other pharmacological treatment options depending on their predominant symptoms. For example, those with constipation predominant symptoms may benefit from secretogogues or prokinetic agents while those with diarrhea predominant symptoms may benefit from a gut-specific antibiotic, 5-HT3 antagonists, u-opioid agonists, or bile acid sequestrants. Anti-spasmodics, probiotics, anti-depressants and psychological therapies are also useful in some patients particularly those with pain-predominant symptoms. |
